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Updated: May 9, 2026
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Impact of regular collaboration between infectious diseases and critical care practitioners on antimicrobial
Ramzy H Rimawi1, Mark A Mazer, Dawd S Siraj
1Division of Infectious Diseases, Brody School of Medicine-East Carolina University, Greenville, NC, USA. RamzyRimawi@hotmail.com
Objective:
Antimicrobial stewardship programs have been shown to help reduce the use of unnecessary antimicrobial agents in the hospital setting. To date, there has been very little data focusing on high-use areas, such as the medical ICU. A prospective intervention was done to assess guideline compliance, antimicrobial expenditure, and healthcare cost when an infectious disease fellow interacts regularly with the medical ICU team.
Design:
A 3-month retrospective chart review was followed by a 3-month prospective intervention the following year. Two hundred forty-six total charts were reviewed to assess generally accepted guideline compliance, demographics, and microbiologic results.
Setting:
Twenty-four-bed medical ICU at an 861-bed tertiary care, university teaching hospital in North Carolina.
Subjects:
Patients receiving antibiotics in the medical ICU.
Intervention:
During the intervention period, the infectious disease fellow reviewed the charts, including physician notes and microbiology data, and discussed antimicrobial use with the medical ICU team.
Measurements And Main Results:
Antimicrobial use, treatment duration, Acute Physiology and Chronic Health Evaluation II scores, length of stay, mechanical ventilation days, and mortality rates were compared during the two periods.
Results:
No baseline statistically significant differences in the two groups were noted (i.e., age, gender, race, or Acute Physiology and Chronic Healthcare Evaluation II scores). Indications for antibiotics included healthcare-associated (53%) and community-acquired pneumonias (17%). Significant reductions were seen in extended-spectrum penicillins (p=0.0080), carbapenems (p=0.0013), vancomycin (p=0.0040), and metronidazole (p=0.0004) following the intervention. Antimicrobial modification led to an increase in narrow-spectrum penicillins (p=0.0322). The intervention group had a significantly lower rate of treatments that did not correspond to guidelines (p<0.0001). There was a reduction in mechanical ventilation days (p=0.0053), length of stay (p=0.0188), and hospital mortality (p=0.0367). The annual calculated healthcare savings was $89,944 in early antibiotic cessation alone.
Conclusion:
Active communication with an infectious disease practitioner can significantly reduce medical ICU antibiotic overuse by earlier modification or cessation of antibiotics without increasing mortality. This in turn can reduce healthcare costs, foster prodigious education, and strengthen relations between the subspecialties.
Insights
An infectious disease fellow
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Health Economics
Background:
- Antimicrobial stewardship programs (ASPs) are crucial for reducing unnecessary antimicrobial use in hospitals.
- Data on ASP effectiveness in high-use areas like the medical intensive care unit (MICU) is limited.
- This study evaluated the impact of an infectious disease (ID) fellow's regular interaction with the MICU team.
Purpose of the Study:
- To assess the impact of an ID fellow's regular engagement on guideline compliance, antimicrobial expenditure, and healthcare costs within a medical ICU.
- To evaluate changes in antimicrobial use patterns and patient outcomes following the intervention.
Main Methods:
- A prospective intervention study comparing a 3-month retrospective period with a subsequent 3-month intervention period.
- Reviewed 246 patient charts in a 24-bed medical ICU to assess guideline compliance, demographics, and microbiology.
- An ID fellow actively reviewed charts and discussed antimicrobial therapy with the MICU team during the intervention.
Main Results:
- Significant reductions were observed in the use of extended-spectrum penicillins, carbapenems, vancomycin, and metronidazole (p<0.05).
- The intervention group showed improved adherence to treatment guidelines (p<0.0001), reduced mechanical ventilation days (p=0.0053), and shorter length of stay (p=0.0188).
- Annual healthcare savings of $89,944 were estimated from early antibiotic cessation alone, with a significant reduction in hospital mortality (p=0.0367).
Conclusions:
- Regular interaction with an infectious disease practitioner significantly reduces antimicrobial overuse in the MICU.
- Earlier modification or cessation of antibiotics, facilitated by ID consultation, did not increase mortality.
- This approach lowers healthcare costs, enhances education, and improves interdisciplinary collaboration.
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